"I Love My Partner… So Why Don’t I Want Sex?” Understanding Low Desire, Libido Changes, and HSDD in Women
- Umu Coomber-ARNP-PMHNP-BC
- May 7
- 5 min read
One of the most common—but least discussed—sexual health concerns women bring into our practice is:
“I love my partner, but I have no desire for sex.”" I feel anxious every time he touches me"It feels like I am on hyper alert within my body about everything“I used to feel desire and now it feels completely gone.”" I used to enjoy sex, but now it all feel numb, no pleasure at all, it feels like sex is now a one sided pleasure show".“I worry something is wrong with me.”
Many women initially seek treatment for anxiety, depression, or mood-related concerns—often without realizing that the underlying distress may be connected to their sexual health or intimate relationships.
For some, months of treatment focused solely on anxiety or depression can pass before a deeper issue comes to light: difficulty experiencing sexual desire, pleasure, or enjoyment during intimacy. These conversations are often delayed because many women feel embarrassed, dismissed, or unsure how to bring it up.
Meanwhile, partners may misinterpret these changes as a loss of attraction, emotional disconnection, or uncertainty about the future of the relationship—creating emotional strain for everyone involved.
For many women, low sexual desire can feel profoundly isolating. It may bring guilt, frustration, grief, confusion, and the painful feeling of being disconnected from both their own bodies and their partners.
But low desire is not always “just stress” or “part of getting older.”
In some cases, women may be experiencing Hypoactive Sexual Desire Disorder (HSDD)—a recognized sexual health condition involving persistent low desire that causes significant personal distress.
And importantly: treatment options have evolved.
At AXXIUMS, we believe sexual wellness deserves the same thoughtful, evidence-informed care as any other health concern.
What Is HSDD?
Hypoactive Sexual Desire Disorder (HSDD) is characterized by:
Persistent lack of sexual desire
Reduced sexual thoughts or fantasies
Reduced motivation to engage in intimacy
Decreased responsiveness to sexual cues
Ongoing symptoms lasting 6 months or longer
Significant personal distress related to low desire
That last point matters.
Not everyone with a lower libido has HSDD.
Some individuals naturally have lower sexual desire and feel completely comfortable with that.
HSDD is diagnosed when the loss of desire feels distressing, disruptive, and inconsistent with a person’s normal baseline. International Society for the Study of Women’s Sexual Health estimates approximately 1 in 10 women may experience HSDD, though many experts believe the number is underreported.
Low Libido vs. HSDD: What’s the Difference?
Low libido can happen temporarily due to:
Parenting stress
Career burnout
Sleep deprivation
Relationship conflict
Major life transitions
Temporary hormonal shifts
That doesn’t automatically mean someone has HSDD.
HSDD involves:
✔ Persistent symptoms
✔ Significant distress
✔ Longer duration
✔ Impact on emotional wellbeing or relationships
Sexual desire naturally fluctuates throughout life—but persistent distress deserves evaluation.
Why Sexual Desire Is More Complex Than People Realize
Desire is not controlled by one hormone.
It involves a complex interaction between:
Brain neurotransmitters
Hormones
Mental health
Relationship dynamics
Nervous system regulation
Physical health
Body image
Trauma history
Sleep quality
Stress levels
Neurotransmitters involved in sexual desire include:
Dopamine
Norepinephrine
Melanocortin pathways
Oxytocin
Sexual inhibition pathways may also suppress desire.
This helps explain why “just try harder” is not effective advice.
Common Causes of Low Sexual Desire in Women
Hormonal Changes
Declining hormones can affect desire:
Perimenopause
Menopause
Postpartum changes
Breastfeeding
Low testosterone states
Thyroid dysfunction
Autoimmune and inflammation
Some women also experience untreated vaginal dryness or painful intercourse, which can further reduce desire.
Medication Side Effects
Several medications may impact libido:
SSRIs
Birth control pills
Blood pressure medications
Some anxiety medications
Certain hormonal treatments
Mental Health Factors
Anxiety
Depression
Burnout
Chronic stress
Trauma history
Religious shame
Poor self-esteem
Relationship Factors
Communication breakdown
Emotional disconnection
Unresolved resentment
Partner sexual dysfunction
Lack of emotional safety
Medical Conditions
Underlying health conditions may contribute:
Diabetes
Chronic pain
Thyroid disorders
Autoimmune illness
Pelvic pain disorders
Fatigue disorders
Therapy Still Matters-Let get comfortable talking about sex therapy
Medication alone may not solve low desire if deeper issues remain unaddressed.
Helpful therapies include:
Sex therapy
Trauma therapy
Cognitive Behavioral Therapy
Couples counseling
Mindfulness-based therapy
For many women, desire improves when emotional safety improves.
Newer Medical Treatments for HSDD
This is where many women are surprised.
There are now few FDA-approved and many off-label options that may help.
Lifestyle Factors That Can Improve Desire
Often overlooked contributors include:
Sleep optimization
Exercise
Stress reduction
Alcohol reduction
Better relationship communication
Managing chronic illness
Improving body confidence
Sometimes libido improves when exhaustion improves.
When to Seek Help
Talk to a medical professional if:
Low desire lasts longer than 6 months
You feel distressed by your symptoms
Your relationship is being impacted
Pain during sex exists alongside low desire
Medication side effects may be involved
You Are Not “Broken”
Low desire is often multifactorial—not a reflection of your worth, attractiveness, femininity, or relationship value. Sometimes your hormones need support. Sometimes your nervous system needs safety. Sometimes your relationship needs communication. Sometimes your medications need adjusting. And sometimes it’s a combination of all of the above. You deserve comprehensive care that treats sexual health as real healthcare.
At Axxiums,
We understand that women’s sexual health has historically been ignored, minimized, or dismissed. That is changing. Today, women have more options than ever—from therapy and hormonal care to FDA-approved medications and personalized treatment strategies.
Your sexual wellbeing matters.
And asking for help is a powerful first step.
For personalized guidance related to Sexual Health and integrative mental health and wellness, we invite you to establish a care relationship with a licensed Board Certified clinician at Axxiums.
We proudly serve adult clients virtually via telehealth. Contact us to learn more about availability in your area.
Resources
International Society for the Study of Women’s Sexual HealthAmerican College of Obstetricians and Gynecologists
Cleveland ClinicMayo Clinic
This article is for educational purposes only and should not replace individualized medical care. Speak with a qualified healthcare professional before starting any medication or treatment plan.
HSDD, Sexual Anhedonia, Lack of Organism, Lack of Sexual pleasure from intercourse, Painful or Sensitivite Intercourse or penetration. Maryland: Baltimore, Bethesda, Columbia, Germantown, Silver Spring, Waldorf, Frederick, Ellicott City, Glen Burnie, Rockville, Gaithersburg, College Park, Towson, Salisbury, Frostburg, Annapolis,Frederick County MD, Carroll County MD, Howard County MD, Montgomery County MD, Washington County MD Virginia: Virginia Beach, Chesapeake, Arlington, Richmond, Norfolk, Newport News, Alexandria, Hampton, Suffolk, Roanoke, Lynchburg, Charlottesville, Blacksburg, Williamsburg, Fairfax, Harrisonburg, Radford, Loudoun County (VA)
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